Rapid and Correct Prediction of Thrombocytopenia and Hypofibrinogenemia with Rotational Thromboelastometry in Cardiac Surgery Reconsidered

Kuiper, Gerhardus J.A.J.M.; Henskens, Yvonne

doi:10.1053/j.jvca.2016.04.009

Cited by 2 publications

(3 citation statements)

References 2 publications

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“…However, the platelet count predicted by EXTEM A10 = 40 mm was much lower in our patients, namely 68 × 10 3 platelets/µL. Furthermore, the large scattering of values, associated with a wide prediction interval, contradicted a clinically useful prediction of platelet count by ROTEM, as proposed previously [30], in our patients. As a consequence, the therapeutic decision to transfuse platelets would vary markedly in our patient cohort, depending on the test method used for decision support.…”

Section: Discussioncontrasting

confidence: 76%

“…As stated previously, viscoelastic test results are influenced by platelet function, which is regularly impaired after cardiac surgery with extracorporeal circulation [28,29]. The impact of platelet count and platelet function on ROTEM amplitude has been discussed controversially: whereas some authors proposed the predictability of platelet count by ROTEM, others questioned this approach [30,31].…”

Section: Discussionmentioning

confidence: 99%

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Rotational thromboelastometry and conventional coagulation tests in patients undergoing major cardiac or aortic surgery: a retrospective single-center cohort study

Keyl

Bashota

Beyersdorf

et al. 2021

J Thromb Thrombolysis

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Algorithms for treatment of diffuse bleeding in cardiac surgery are based on intervention thresholds of coagulation tests, such as rotational thromboelastometry (ROTEM) or conventional laboratory tests. The relationship between these two approaches is unclear in patients with increased risk of coagulation abnormalities. We retrospectively analyzed the data of 248 patients undergoing major cardiac and/or aortic surgery. ROTEM and conventional laboratory tests were performed simultaneously after termination of cardiopulmonary bypass and protamine administration to investigate the extrinsic and intrinsic system, and to determine deficiencies in platelets and fibrinogen. We evaluated the association between ROTEM and conventional tests by linear regression analysis and compared the frequency of exceeding established thresholds for clinical intervention. Significant linear associations between ROTEM 10 min after the start of coagulation, and plasma fibrinogen concentration or platelet count (FIBTEM A10, R2 = 0.67, p < 0.001; EXTEM A10, R2 = 0.47, p < 0.001) were obtained. However, the 95% prediction intervals exceeded clinically useful ranges (92–233 mg/dL fibrinogen at the intervention threshold of FIBTEM A10 = 10 mm; 14 × 103–122 × 103/µL platelets at the intervention threshold of EXTEM A10 = 40 mm). The association between EXTEM and INR (R2 = 0.23), and INTEM and aPTT (R2 = 0.095) was poor. The frequency of exceeding intervention thresholds and, consequently, of triggering treatment, varied markedly between ROTEM and conventional tests (p < 0.001 for all comparisons). The predictability of conventional coagulation test results by ROTEM is limited, thus hampering the interchangeability of methods in clinical practice.

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Section: Discussioncontrasting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Rotational thromboelastometry and conventional coagulation tests in patients undergoing major cardiac or aortic surgery: a retrospective single-center cohort study

Keyl

Bashota

Beyersdorf

et al. 2021

J Thromb Thrombolysis

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“…PLTEM was calculated by subtracting maximum clot firmness for FIBTEM from maximum clot firmness for EXTEM, as PLTEM might correlate better with platelet count and function than EXTEM. 14 Severity of Crimean-Congo haemorrhagic fever was assessed in all patients by use of Swanepoel criteria, 15 the severity grading score (SGS), 16 and severity scoring index (SSI), 17 for the first 5 days of illness (appendix). Patients presenting more than 5 days after onset of illness were given an SSI score at admission.…”

Section: Methodsmentioning

confidence: 99%

Rotational thromboelastometry alongside conventional coagulation testing in patients with Crimean–Congo haemorrhagic fever: an observational cohort study

Fletcher

Leblebicioğlu

Bozkurt

et al. 2019

The Lancet Infectious Diseases

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Background Data describing the coagulopathy of Crimean-Congo haemorrhagic fever are scarce. We did rotational thromboelastometry (ROTEM) and conventional coagulation testing in patients with Crimean-Congo haemorrhagic fever to increase our understanding of the coagulopathy of this infectious disease. MethodsWe did a prospective observational cohort study of adults aged 18 years and older and admitted to hospitals with PCR-confirmed Crimean-Congo haemorrhagic fever in Samsun and Tokat, Turkey. Demographic, clinical, and laboratory data were collected and blood samples for ROTEM analysis and coagulation testing were drawn at admission and during hospital admission and convalescence (up to 30 days after onset of illness). For the ROTEM analysis we recorded the following extrinsically activated ROTEM (EXTEM S) variables, with normal ranges indicated: clotting time (38-79 s), clot formation time (34-159 s), amplitude at 10 min after clotting time (43-65 mm), maximum clot firmness (50-72 mm), and maximum lysis (>15% at 1 h). The following fibrin-specific ROTEM (FIBTEM S) variables were also recorded: amplitude at 10 min after clotting time (normal range 7-23 mm) and maximum clot firmness (9-25 mm). Disease severity was assessed by Swanepoel criteria, severity grading score (SGS), and the severity scoring index (SSI), with mild disease defined as meeting no Swanepoel criteria, graded mild by SSI, and graded low risk by SGS. Findings Between May 27, 2015, and Aug 2, 2015, 65 patients with confirmed Crimean-Congo haemorrhagic fever were recruited and had blood taken at 110 time points. Most were male (40 [62%] of 65) with mild disease (49 [75%] of 65). Haemorrhage occurred in 13 (20%; 95% CI 11•1-31•8) of 65 patients and 23 (35%) of 65 received blood products (15 received fresh frozen plasma and eight received red blood cell concentrates), and 21 patients received platelet transfusions. At admission, the following EXTEM S variables differed significantly between mild cases and moderate to severe cases: median clotting time 56 s (range 42-81; IQR 48-64) versus 69 s (range 48-164; IQR 54-75; p=0•01); mean amplitude at 10 min after clotting time 45•1 mm (SD 7•0) versus 33•9 mm (SD 8•6; p<0•0001); median clot formation time 147 s (range 72-255; IQR 101-171) versus 197 s (range 98-418; IQR 156-296; p=0•006); and maximum clot firmness 54•4 mm (SD 7•2) versus 45•1 mm (SD 12•5; p=0•003). The EXTEM S variables were compared at different time points; maximum clot firmness (p=0•024) and amplitude at 10 min after clotting time (p=0•090) were lowest on days 4-6 of illness. We found no significant differences in FIBTEM variables between mild and moderate to severe cases (median amplitude at 10 min, 13 mm [range 8-20; IQR 11-15] vs 12 mm [range 6-25; IQR 10-15; p=0•68]; and median maximum clot firmness, 15 mm [range 9-60; IQR 13-21] vs 17 mm [range 7-39; IQR 13-23; p=0•21]); and no hyperfibrinolysis (maximum lysis >15%).Interpretation Coagulopathy of Crimean-Congo haemorrhagic fever is related to defects in clot development and stabilis...

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Rapid and Correct Prediction of Thrombocytopenia and Hypofibrinogenemia with Rotational Thromboelastometry in Cardiac Surgery Reconsidered

Cited by 2 publications

References 2 publications

Rotational thromboelastometry and conventional coagulation tests in patients undergoing major cardiac or aortic surgery: a retrospective single-center cohort study

Rotational thromboelastometry and conventional coagulation tests in patients undergoing major cardiac or aortic surgery: a retrospective single-center cohort study

Rotational thromboelastometry alongside conventional coagulation testing in patients with Crimean–Congo haemorrhagic fever: an observational cohort study

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